Client Care & Consent Form

Website

Fields marked with * are required.

Full Name

Phone (Optional)

Email

Are you over 18 years of age?
Please select Yes No

Have you had a professional massage before?
Please select Yes No

Do you have any allergies?
Please select No Yes

Do you have any medical conditions, or are you currently taking any medication?
Please select No Yes

Have you had any recent injuries, surgeries, fractures, or hospital treatment?
Please select No Yes

Are you currently pregnant or breastfeeding?
Please select No Yes

Do you have any skin conditions, infections, or varicose veins?
Please select No Yes

Do you experience any areas of chronic pain, discomfort, or tension?
Please select No Yes

Is there anything else you would like me to know to help you feel comfortable during your session? (Optional)

Submit & Continue